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KLSG12/F01B

Details of Infrastructure facilities of Institutes for considering as Test Centre under Skill Development Initiative (SDI) Scheme based on MES by DGE&T Ministry of Labour & Employment, Government of India Assessing Body : KITCO Ltd., KITCO Placement Park Little Flower Campus, NH-47, South Kalamassery, Kochi 682 022

Name of Promoter / Director Name and address of the Institute (Nature of incorporation, year of establishment & no. of years in service)

Telephone No- Office: Residence: Mobile: Fax: E- mail Details of courses conducted (Name of course, duration, Diploma / Certificate, No. of students/ batch, No. of batches / year, Fee structure, Syllabus etc.)

Infrastructure facilities available (Classrooms, Lab, office, staff room, library etc with space available for each (sq.ft.)

(Attach separate sheet, if necessary) Details of facility in the lab / workshop (Description of equipment / machinery / instruments)

(Attach separate sheet, if necessary)

I, the undersigned, do hereby declare that the above-furnished data are true. I agree that I am willing to provide facilities for conducting test in this institute, if selected as a Test Centre. Place: Date:

Signature

E:\2008\SDI MC 019\Formats\Preliminary Data Sheet-TC.doc